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General NPI Number Information
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NPI Number | 1992459184
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Entity Type | Individual
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Provider Name | DHAVAL JAYMIN SHAH
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Gender | Male
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 634 ANDERSON AVE
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1811
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Country | US
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Telephone | 201-945-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 965 LAKEVILLE RD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3008
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Country | US
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Telephone | 516-320-4845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI03029400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI03029400
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License Number State | NJ
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